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Omphalocele and gastroschisis: Black-White disparity in infant survival
Hamisu M Salihu1, Zakari Y Aliyu, Bosny J Pierre-Louis
1Department of Maternal and Child Health, University of Alabama at Birmingham, 35294, USA. hsalihu@uab.edu
Insights
Infant survival rates for gastroschisis and omphalocele vary significantly by race. Black infants with omphalocele have better survival, while those with gastroschisis face worse outcomes compared to White infants.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Medical Genetics
Background:
- Racial and ethnic disparities in congenital anomalies are known.
- Understanding the impact of race/ethnicity on infant survival with abdominal wall defects is crucial.
Purpose of the Study:
- To investigate if race/ethnicity influences survival rates in infants diagnosed with gastroschisis or omphalocele.
- To compare mortality differences across racial/ethnic groups for these specific birth defects.
Main Methods:
- Analysis of 1481 cases of gastroschisis and omphalocele from the New York Congenital Malformation Registry (1983-1999).
- Utilized Proportional Hazards Regression to calculate adjusted and unadjusted hazard ratios for survival.
- Compared all-cause mortality among Black, Hispanic, and White infants with these defects.
Main Results:
- Overall infant mortality rate was 182 per 1000, with most deaths in the first 28 days.
- Omphalocele had a higher infant mortality rate (215 per 1000) than gastroschisis (118 per 1000).
- Black infants with omphalocele showed better survival than Whites (AHR=0.52), but worse survival with gastroschisis (AHR=2.23). Hispanic infants had similar mortality risks to Whites.
Conclusions:
- The natural history of omphalocele and gastroschisis is race-dependent.
- Black infants with omphalocele have improved survival, whereas Black infants with gastroschisis have poorer survival outcomes compared to White and Hispanic infants.
Background:
Racial/ethnic variations in the occurrence of abdominal wall defects have been previously noted but it remains poorly understood whether race/ethnicity is a determinant of survival among affected infants.
Methods:
Study was conducted on cases of gastroschisis and omphalocele recorded for the years 1983-1999 at the New York Congenital Malformation Registry. Adjusted and unadjusted hazard ratios were generated from a Proportional Hazards Regression model to compare survival among affected Blacks, Hispanics and Whites. The major end point of analysis was differences in all cause mortality among infants with abdominal wall birth defects across different racial/ethnic groups.
Results:
Among the three racial/ethnic groups, 1481 infants were diagnosed with either omphalocele (978 or 66%) or gastroschisis (503 or 34%). Overall infant mortality rate (IMR) was 182 per 1000, with 74% of the deaths occurring within the first 28 days of life. Omphalocele infants had significantly higher infant mortality (IMR = 215 per 1000) than infants with gastroschisis (IMR = 118 per 1000)[p < 0.0001]. Overall, Black infants with abdominal wall defects had lower mortality indices than Whites and Hispanics. However, when considered as separate disease entities, Black infants were twice as likely to survive as compared to Whites if they had omphalocele [Adjusted Hazard Ratio (AHR) = 0.52; 95% Confidence Interval (CI) = 0.37-0.74], and twice as likely to die as Whites if they had gastroschisis instead (AHR = 2.23; 95% CI = 1.16-4.28). For both defect subtypes, Hispanics have risks for infant mortality comparable to Whites.
Conclusions:
The natural history of omphalocele and gastroschisis co-varies with race. Black infants with gastroschisis have worse survival outcomes while those with omphalocele have better chances of survival than their White or Hispanic counterparts.
